Partial Removal of Intestines in Crohn’s Disease Patients

Written by Stephanie Faris
| Published on March 4, 2012Medically Reviewed by George Krucik, MD

When medications aren’t working, some Crohn’s patients turn to surgery. Find out if partial removal of the intestines may help and what the procedure entails.

Crohn’s disease
creates problems—generally in the form of inflammation that causes painful and
difficult symptoms—in the intestinal tracts of sufferers. These symptoms can
get in the way of living a normal life, as frequent bouts of diarrhea will
cause running to the bathroom throughout the day. As a result, many Crohn’s sufferers
spend years trying various medications to find one that provides relief from
these symptoms. When medication doesn’t work or complications develop, some
will turn to surgery to find relief.

Several surgeries
are available for Crohn’s sufferers, one of which involves removing part of the
colon or intestines. Whether the patient requires removal of the colon or the
intestines, it’s important to note that there’s still no cure for Crohn’s. Even
with removal of the affected part of the intestines, a patient may find that
over time, Crohn’s begins to affect a new part of the gastrointestinal tract
and cause the symptoms to reappear.

Resectioning the Intestines

Removal of part
of the intestines is called a resection. A resection is generally ordered when
the patient suffers one or more strictures (diseased areas) close together in a
particular area. It involves removing part of the intestines, then suturing the
remaining sections together in what is called an anastomosis.

While resection
surgery can usually resolve symptoms, at least temporarily, some patients
suffer nutritional deficiencies because of it. Once resectioning has occurred,
a patient has a lower surface area in the intestines in which nutrients can be
absorbed. Because of this, a patient will usually be put on a regimen of
supplements to ensure they’re receiving proper nutrition.

In resectioning,
the surgeon will remove as little of the intestines as necessary.
Unfortunately, once this section has been removed, another part of the intestines
may eventually become affected,
requiring another surgery. Often, inflammation will occur at the area of
anastomosis.

?For partial
removal of intestines, the surgeon will remove the diseased section and
reattach the functioning sections while the patient is under anesthesia. The
procedure generally takes one to four hours and contains the usual risks during
surgery, including risk of infection and blood clots.

Recovery for
partial removal of intestines generally takes four to six weeks. During
recovery, the doctor will likely recommend a low-fiber diet to allow the digestive
tract time to heal.

The Importance of Quitting Smoking After Surgery

About
half of Crohn’s patients who undergo surgery will have a recurrence of
symptoms. This has many patients asking how to avoid recurrence. Several
lifestyle modifications can be made that will help a patient maintain remission
as long as possible, one of which is to cease smoking. Smoking has not only
been pinpointed as a possible risk factor for Crohn’s, it’s also been found to
raise the risk of recurrence among Crohn’s patients in remission. Some studies
have shown that smokers in remission from Crohn’s are twice as likely to have a
recurrence of symptoms as non-smokers in remission. Recent studies have also
shown that the overall lifelong health of a Crohn’s sufferer is improved when
smoking is discontinued.

Medications After Surgery

Antibiotics are
often a less-potent solution to preventing recurrence in Crohn’s patients who’ve
had resectioning. Metronidazole in oral dosing can help prevent recurrence in
these patients and are safe enough to take long-term. Sold as Flagyl,
metronidazole cuts down on bacterial infections in the intestinal tract, which
helps keep symptoms at bay. Like any antibiotic, however, over time it will
become less effective as the body adjusts.

Aminosalicylates,
also known as 5-ASA, have been found to be effective in Crohn’s patients under
remission. These aminosalicylates sometimes contain sulfasalazine, which has
negative effects on the many patients who have an intolerance to it. Headaches,
diarrhea, nausea, and rashes are some of the side effects. Some side effects
may be minimized by taking the medication with food.

Budesonide is
sometimes prescribed for post-resection patients. Generally prescribed for
sinus issues and allergies, Budesonide is a steroid sold ?under the brand names
Rhinocort, Pulmicort, and Entocort. In Crohn’s patients, budesonide works to
reduce inflammation in the intestines, acting once it comes in contact with the
affected tissues. It acts via slow release: the liver breaks it down into
chemicals that then work to lower inflammation. Budesonide has not been
clinically proven to be effective in maintaining long-term remission in Crohn’s
patients, so although it’s relatively safe, it may not be the best medication
to meet your remission goals.

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